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Business Profile

HMOs

Anthem Blue Cross And Blue Shield

This business is NOT BBB Accredited.

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Complaints

This profile includes complaints for Anthem Blue Cross And Blue Shield's headquarters and its corporate-owned locations. To view all corporate locations, see

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    Customer Complaints Summary

    • 45 total complaints in the last 3 years.
    • 13 complaints closed in the last 12 months.

    If you've experienced an issue

    Submit a Complaint

    The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

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    Complaint status

    Complaint type

    • Initial Complaint

      Date:03/16/2025

      Type:Service or Repair Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Anthem has changed my PCP WITHOUT MY KNOWLEDGE OR CONSENT!! they now claim that i have a new PCP who IS NOT IN NETWORK!! MY PCP is and should be Dr. ******* HE IS IN NETWORK! This is now the SECOND TIME that Anthem has done this to me and last time in took them 6 incompetent months to get it sorted out! MY PCP IS DR ****** and I HAVE A MEDICAL CONDITION AND DO NOT WANT AND DO NOT APPROVE OF A CHANGE IN PCP ESPECIALLY WITHOUT KNOWLDEGE OR CONSENT!

      Customer Answer

      Date: 03/20/2025

      Anthem after REPEATED calls REFUSES to update PCP!!! My doctor's office called them on 3/19/25 with the required information. I have called Anthem MULTIPLE TIMES 3/20/25. First I was told they couldn't fix it. Then i was told the supervisor ***** would get back to me later in the day which NEVER HAPPENED! When attempting multiple calls to Anthem, I was place on hold and then HUNG UP ON!!! I tried to reach a supervisor for over an HOUR! NO SUPERVISOR was EVER reached! Anthem REFUSES to call my doctor for information, has assigned me a PCP OUT OF NETWORK, claims my doctor is not a current PCP and REFUES to send card with my PCP on it. Due the INCOMPETENCE of Anthem, now I have to go find a new PCP since they REFUSE to update my provider's infomation- even AFTER his office CALLED and updated it with Athem 3/19/25!

    • Initial Complaint

      Date:03/08/2025

      Type:Product Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I have been paying my premiums monthly and on time, the latest being on 2/25/25 for the month of March. They even sent a confirmation email and showed online that I am paid up. Today I got an email claiming that I am past due for the March premium! I am not! They are trying to scam me out of an extra $227.57.Attached is confirmation for payments for January, February and March.

      Customer Answer

      Date: 03/18/2025

      Is there a way to change this to resolved? I wound up calling them for a different concern and they explained that the reason they say I was behind on premium payments was because the amount I thought was going towards the January payment was used to pay for an old premium that did not go through. They did not inform me back then, which is irresponsible on their part, but other than that, it turned out I did indeed owe them one more premium payment to be caught up.

    • Initial Complaint

      Date:01/27/2025

      Type:Sales and Advertising Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I had a surgery with valley view hospital, this was not a workers comp claim and anthem is denying to pay this claim after I had met my deductible.

    • Initial Complaint

      Date:12/28/2024

      Type:Sales and Advertising Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Anthem Blue Cross and Blue Shield has a provider search tool that lists local in-network providers that can be used for doctors visits. I have had some ongoing treatment with provider whose *** (National Provider Identifier) is listed as an in-network provider for Anthem. I have spoken to multiple support staff with Anthem who confirm that this provider is in-network. However Anthem has denied claims for the dates: 11/15/24, 11/08/24, 08/01/24, 07/19/24, 07/11/24, 07/05/24, 06/27/24, and 06/13/24. The reason these claims were denied is because they were "out-of-network". Anthem has paid numerous other claims with this provider as in-network. I have called multiple times and each time they say they need 60 days to review the claims. The 60 day period has passed and the claims were denied again. I don't believe that any genuine effort is going toward resolving this issue.I would like for Anthem to honor their EOB (Explanation of Benefits) by approving these in-network claims for a covered procedure.

    • Initial Complaint

      Date:12/06/2024

      Type:Service or Repair Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Anthem Blue Cross Blue Shield has been contacted numerous times by phone, email and internal messaging. I have only been able to talk with a call center and the employees have placed me on hold for long periods of time as though they have no idea how to understand their own practices and how claims work in addition to not being able to solve any problems. My daughter ********** ***** went for her 4 month well care visit on 10/28/2024 and the claim was denied. All wellcare visits are supposed to be covered 100%. I was told that we hit our maximum number of visits (there are 7 in a year) however, we have not. I asked for the claims that were accounting for the 7 visits and 4 of them were Lactation Consultant Appointments that are not wellcare visits and were also NOT covered 100%. I have the claims attached that are being adjudicated as wellcare visits and below are the *** codes. The Agent told me that the lactation visits are not coded as wellcare visits and should not be assigned as such. However, they couldn't do anything. I paid $135 to my pediatrician as a result that I should be paid back. DOS: 07/01/2024 Claim # *******MA8254 *** CODE: ***** , S9443 DOS: 07/03/2024 Claim# *******MB6729 *** CODE: ***** , S9443 DOS: 07/10/2024 Claim # *******ME8006 *** CODE *****, S9443 DOS: 08/06/2024 Claim # *******MC2427 *** CODE: *****, S9443 Anthem Blue Cross Blue Shield should also be looked into as many claims are being processed incorrectly and I cannot get a solid answer. I get responses from the internal message board that do not answer the question and answer other questions. When I call, no one has any understanding of how their systems work and I am placed on hold for very long periods of time. This has become a scam because they are denying more claims that should never be denied and you cannot get a hold of anyone that can do anything about it. The appeal process is very long and every appeal is still not properly reviewed or resolved.

    • Initial Complaint

      Date:11/13/2024

      Type:Order Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I have a contract as a network provider through Anthem **** since 11/15/21 and they are now processing my claims as an out of network provider since 10/21/2024, in breach of my contract and their member's contract of using a network provider. I have contacted credential multiple times. It has been confirmed by credentialing that I remain in network. However, claims continue to processed as out of network. I have contacted multiple departments at Anthem BCBS and have received no assistance other then to call a different department for assistance because their department does not handle this. Claims has told me to contact credentialing/Provider support and credentialing/provider support has told me to contact claims.

    • Initial Complaint

      Date:09/28/2024

      Type:Service or Repair Issues
      Status:
      Unresolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Unable to get care after hours of just trying to get an appointment for a physical. Physical is covered under my plan with no deductible, but after hours on the phone with nice people, was given an appointment only to get a quote for the cost which was $270. I cancelled the appointment and am back at **********. This company assigned me an out of network provider which I couldn't correct on the website. It necessitated quite a bit on time and energy only to get an appointment (and was told I was not guaranteed routine bloodwork with this doctor) with someone who per my plan will cost me almost $300 to see for something that is supposed to be covered. It is clear this company wants to make it difficult and time consuming to get even basic care. It seems clear that they don't want you to use the insurance you paid for with ease, but they would rather you give up. The WORST experience with insurance I've had in my life.

    • Initial Complaint

      Date:09/04/2024

      Type:Service or Repair Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      Claim for MRI was incorrectly denied. I appealed it, and that appeal was incorrectly filed so was denied. Filed a new appeal that was escalated, and they are now also saying denied as out of network. It is not out of network, as I verified with the facility and anthem before receiving **** Anthem also sent me a letter approving the **** Now they want to file another claim, and wait another ***** days. The most frustrating part of all this, is that THEY KEEP HANGING UP ON ME! Any time I relate that I am frustrated, or ask to speak to a supervisor, they just hang up. I find this unacceptable. I have called over 10 times, and spent hours on this.

    • Initial Complaint

      Date:07/16/2024

      Type:Product Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I have sent 3 requests to Anthem requesting a rate increase consideration for my business as I am a mental health provider for them. These requests were sent via email on November 14, 2023, August 24, 2023, September 29, 2023. I am an LCSW and have been serving clients through Carelon/Anthem BCBS since 10/1/2021 and have over 5 years of experience as a managed care provider. Since emailing them I have received no response not even recognition that they have received my request. The demand for services and referral rate is outpacing the availability I have. With that demand has also come increased overhead costs to match current inflation trends. I hope to be able to continue make the important services I offer available to your customers which is why I am requesting an adjustment in rates to match demand for services and the unique and specialized services I offer.I have pursued extensive additional training to offer unique and specialized psychotherapy services. These include trainings in: EMDR Basic and Advanced training to treat individuals with early childhood trauma Dialectical Behavior Therapy Cognitive Behavior Therapy *************** Systems Clinical Supervision Furthermore, I also serve the following specialized populations: Adolescence/teens and their families PTSD Borderline Personality ************************** care I also offer evening and weekend appointment hours to meet the academic and work needs of my clients in addition to offering telehealth services to broaden the geographical range of clients I can serve.Below are my current rates and my requested rates:PPO CPT Code Current Rates Requested Rates ***** $104 $134 ***** $93 $123 ***** $79 $109 ***** $51 $71 ***** $109 $129 ***** $81 $101 ***** $81 $101 ***** $44 $64 HMO CPT Code Current Rates Requested Rates ***** $83 $123 ***** $77 $113 ***** $66 $86 ***** $36 $66 ***** $95 $115 ***** $66 $96 ***** $66 $96 ***** $38 $58

    • Initial Complaint

      Date:07/15/2024

      Type:Service or Repair Issues
      Status:
      Unanswered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      On 1/20/24 I was taken by ambulance to a hospital for a medical emergency. They took me to a hospital that was out of network. My plan Anthem Silver Pathway HMO says that emergency room care that is out of network is covered as in network on my benefits statement. Anthem has denied ******* of charges for claim 2024030EV8742. These charges consist of pain medication, the IV bag of fluids, labs that were run including (lipase assay, HCG panel, and a metobolic panel, and costs for the doctors and nurses to care for me while I was there. That portion of the claim is being denied that I should pay for the entire amount due to being out of network but my plan specifically states this will be billed for in network care and covered. I have called twice to get this rectified. The first time more of all the bills were taken care of so that my portion would be less an Anthem is not required to pay this is just to be applied to my deductible and out of network costs. I have called again to no avail even though this is what my plan states in my portal. I was on the phone for over an hour and waiting for a manager for over thirty minutes. Please help. I cannot afford 7000 after already paying all the money I did as I was transferred after to an in network hospital and then had emergency surgery.

    Anthem Blue Cross And Blue Shield is NOT a BBB Accredited Business.

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